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HIGH CHOLESTEROL ABSORPTION IS ASSOCIATED WITH INCREASED CARDIOVASCULAR RISK IN HEMODIALYSIS PATIENTS: INSIGHTS FROM THE AURORA STUDY
Abstract
Background and Aims
Statin treatment did not reduce the risk of cardiovascular events in hemodialysis patients in the 4D and AURORA trials. Cholesterol absorption was associated with vascular risk and risk reduction by atorvastatin in the 4D study.
Methods
AURORA is a randomized, double-blind, placebo-controlled, multicenter trial in hemodialysis patients. The participants were randomly assigned to receive either rosuvastatin, 10 mg daily, or matching placebo. There was a follow-up for cardiovascular death with a median duration of 3.9 years. The cholestanol to cholesterol ratio was used to estimate cholesterol absorption.
Results
Measurement of non-cholesterol sterols was available in 2,332 participants of the 2,733 patients included in the primary analysis of the AURORA study. A total of 598 participants died from cardiovascular diseases. The 3rd vs. the 1st tertile of the cholestanol to cholesterol ratio was significantly associated with increased risk of cardiovascular death (Hazard ratio [95% confidence interval] = 1.36 [1.11-1.65]) in univariate (p = 0.002) and multivariate models (p = 0.034). There was no significant interaction between the cholestanol to cholesterol tertiles and treatment group in predicting cardiovascular death.
Conclusions
The present data from the AURORA Study confirm that high cholesterol absorption is associated with increased cardiovascular risk in hemodialysis patients. Assessment of the individual cholesterol absorption rate to guide initiation of statin treatment is not supported by the findings in the AURORA Study.